Re-emergent tremor in Parkinson's disease: the effect of dopaminergic treatment.

BACKGROUND AND PURPOSE: Patients with Parkinson's disease (PD) with resting tremor may be affected by a tremor that appears after a varying latency while a posture is maintained, a phenomenon referred to as re-emergent tremor (RET). The aim of the study was to evaluate the occurrence and clinical features of RET in patients with PD tested off and on treatment, and to compare the effect of dopaminergic treatment on RET with the effect on resting and action tremor. METHODS: We consecutively enrolled 100 patients with PD. Patients were clinically evaluated 24 h after withdrawal of therapy (off-treatment phase) and 60 min after therapy administration (on-treatment phase). We collected the demographic and clinical data of patients with PD. The severity of the disease was assessed by means of the Hoehn and Yahr scale and Movement Disorder Society-sponsored revision of the Unified Parkinson's Disease Rating Scale part III. We evaluated the latency, severity and body side affected both off and on treatment in patients with RET. RESULTS: Re-emergent tremor was present in 24% of the patients with PD off treatment and in 19% of the patients on treatment. Dopaminergic treatment reduced the clinical severity of RET. Dopaminergic treatment increased the number of patients with unilateral RET and reduced the number of those who had bilateral RET. RET and resting tremor responded similarly to dopaminergic treatment, whereas action tremor was less responsive. Patients with RET had milder motor symptoms than patients without RET both off and on treatment. CONCLUSIONS: Dopaminergic treatment modified RET occurrence, severity and body distribution. Dopaminergic depletion plays a role in the pathophysiology of RET.

Child Abuse and Neglect and its Psycho-Physical and Social Consequences: A Review of the Literature.

Child maltreatment is a complex life experience occurs when a parent or caregiver does an intentional or potential damage to a child, including acts of commission and omission. Child abuse is not an uncommon event, but it is not always recognized. Identifying the real number of maltreated children is a challenge because of the large variability in reported prevalence data across studies. Unfortunately, in the United States, it affects 1 in 8 children, by the age of 18 years, annually. Paediatricians may encounter a variety of forms of maltreatment such as neglect, emotional, physical and sexual abuse. These aspects should be recognised, examined and evaluated by employing a systematic approach and focusing on basic needs of children that may not be met. Child maltreatment is a global problem with serious life-long physical and psychological or psychiatric outcomes. It is associated with important economic and social costs (such as physical and mental health, productivity losses, child welfare, criminal justice and special education costs) due to its high prevalence and its long-term and short-term consequences. In the United States, the average cost of nonfatal maltreatment is $210,012 per children and the cost of fatal maltreatment is $1,272,900. General Practitioners are quite prepared to face the problem of child maltreatment: since they have the opportunity to meet several members of the same family, they can detect stressors that put children at risk of maltreatment. All health professionals have the responsibility to protect children from abuse and neglect.

Nonpsychotic postpartum depression among adolescent mothers.

This study examined the extent to which childbearing increases vulnerability to clinical depression and depressive symptomatology among primiparous adolescent girls (ages 14 to 18). Childbearing Ss (n = 128) were assessed during pregnancy, 6 weeks postpartum, and 1 year postpartum. Matched nonchildbearing Ss (n = 114) were assessed at corresponding time points. Six weeks postpartum, 6% of the childbearing adolescents met Research Diagnostic Criteria for major depression and 20% for minor depression. These rates were not significantly different from those found for nonchildbearing Ss (4% major depression, 10% minor depression). However, higher rates of somatic symptoms of depression were found among the childbearing Ss than among the nonchildbearing Ss.

Objective determinants of perceived social support.

Objective characteristics of people's social networks were examined as determinants of the perceived availability of social support in two populations: elderly adults (n = 50) and mothers of 1-year-olds (n = 71). Number of network members and frequency of contact with network members, computed separately for kin and nonkin were examined as predictors of loneliness, overall social support, and the six components of social support proposed by Weiss (1974). Kin were found to be more effective providers than nonkin of some aspects of social support. Network characteristics were better predictors of perceived social support for the elderly than for the mothers, but a maximum of 30% of the variance in perceived social support was attributable to the objective network characteristics in either sample. It is recommended that future research on the determinants of perceived social support consider actual interpersonal behaviors, their contexts, and personality characteristics that affect the facilitation an interpretation of supportive behaviors.

Ratings of social support by adolescents and adult informants: degree of correspondence and prediction of depressive symptoms.

It has been suggested that the personality of the individual influences appraisal processes that determine ratings of both social support and mental health, thus leading to an association between these variables that reflects only their shared self-report bias. To test whether ratings of social support made by someone other than the target individual would significantly predict outcomes, 115 pregnant adolescent girls and 115 adults who knew the adolescents well both completed ratings of the adolescent's social support. Results showed a moderate level of agreement between adolescent and informant support ratings. Both self-report and informant total social support ratings predicted pregnancy depression scores. Only informant social support ratings were significant predictors of postpartum depression scores. The ability of informants' ratings of social support to predict the adjustment of the adolescents to a major life stress was viewed as evidence that the commonly found link between social support and mental health reflects more than self-report biases.

The revised UCLA Loneliness Scale: concurrent and discriminant validity evidence.

The development of an adequate assessment instrument is a necessary prerequisite for social psychological research on loneliness. Two studies provide methodological refinement in the measurement of loneliness. Study 1 presents a revised version of the self-report UCLA (University of California, Los Angeles) Loneliness Scale, designed to counter the possible effects of response bias in the original scale, and reports concurrent validity evidence for the revised measure. Study 2 demonstrates that although loneliness is correlated with measures of negative affect, social risk taking, and affiliative tendencies, it is nonetheless a distinct psychological experience.

Social and emotional loneliness: an examination of Weiss's typology of loneliness.

This study examined Weiss' conceptualization of social and emotional loneliness. Using data from an extensive survey of undergraduate and graduate students at the University of Iowa, we measured social and emotional loneliness, students' affective and behavioral reactions to loneliness, students' social relationships, and their judgments of the degree to which their relationships supply the six social provisions described by Weiss. As expected, we found differences in the subjective experiences of social and emotional loneliness, although both forms of loneliness were also characterized by a common core of experiences. The results generally supported Weiss's ideas concerning the determinants of social and emotional loneliness. Predictions concerning the affective and behavioral consequences associated with each type of loneliness, however, were only partly supported, although the two forms of loneliness were associated with different affective reactions and coping behaviors. The implications of these findings for Weiss's typology of loneliness are discussed.

Social support and immune function among spouses of cancer patients.

This study investigated whether social support was related to immune function among spouses of cancer patients. Effects of depression and negative life events were examined as potential mediators. Results showed evidence of greater immunocompetence on 2 of 3 dynamic measures: natural killer cytotoxicity and proliferation response to phytohemagglutinin among spouses who reported high levels of social support. All six components of social support assessed by the Social Provisions Scale (Cutrona & Russell, 1987) were strongly related to these indices of immune function. No evidence was found for mediation by either life events or depression.

Direct and moderating effects of community context on the psychological well-being of African American women.

The effects of community characteristics on well-being were examined among 709 African American women. Direct and moderating effects of neighborhood characteristics on distress were tested. Aggregate-level ratings of neighborhood cohesion and disorder were significantly related to distress, although the relation between cohesion and distress became nonsignificant when individual risk factors were statistically controlled. Aggregate-level neighborhood variables interacted significantly with individual risk and resource variables in the prediction of distress, consistent with trait-situation interaction theories (D. Magnusson & N. S. Endler, 1977). Community cohesion intensified the benefits of a positive life outlook. Community disorder intensified both the benefits of personal resources and the detrimental effects of personal risk factors. Results showed evidence of resilience among African American women.

Perceived parental social support and academic achievement: an attachment theory perspective.

The study tested the extent to which parental social support predicted college grade point average among undergraduate students. A sample of 418 undergraduates completed the Social Provisions Scale--Parent Form (C.E. Cutrona, 1989) and measures of family conflict and achievement orientation. American College Testing Assessment Program college entrance exam scores (ACT; American College Testing Program, 1986) and grade point average were obtained from the university registrar. Parental social support, especially reassurance of worth, predicted college grade point average when controlling for academic aptitude (ACT scores), family achievement orientation, and family conflict. Support from parents, but not from friends or romantic partners, significantly predicted grade point average. Results are interpreted in the context of adult attachment theory.

Social support and adaptation to stress by the elderly.

The first of a two-phase project is reported that examined the prospective effects of stress and social support on the physical and mental health of the elderly. A sample of 50 elderly subjects was assessed at two points in time over a 6-month period. Results indicated that social support was a significant predictor of physical health status, whereas mental health was related to the Stress X Social Support interaction term. These latter results were consistent with the buffering hypothesis, in that high levels of social support served to reduce the negative impact of stress on mental health. Individuals who were in better mental health at the initial assessment experienced fewer stressful events and higher levels of social support over the subsequent 6-month period. The implications of these findings for research and theory regarding the relation between stress and social support are discussed.

Social support, stress, and depressive symptoms among the elderly: test of a process model.

Effects of social support, negative life events, and daily hassles on depressive symptoms were assessed in 301 adults aged 65 or older, in person 3 times at 6-month intervals and by mail questionnaires every month over a 12-month period. Initial social support predicted severity of depressive symptoms 12 months later. Social support and initial levels of depressive symptomatology predicted number of daily hassles but not number of major life events. Effects of social support, depression, and major life events on the incidence of daily hassles remained significant without the inclusion of hassles reflecting depressive symptomatology or problems in relationships or whose content overlapped with major life events. Daily hassles mediated the effects of major life events on subsequent depression. Results did not differ for men and women. Implications for models of the relations among social support, stress, and depression are discussed.

Loneliness and nursing home admission among rural older adults.

In this study, the authors tested the relation between loneliness and subsequent admission to a nursing home over a 4-year time period in a sample of approximately 3,000 rural older Iowans. Higher levels of loneliness were found to increase the likelihood of nursing home admission and to decrease the time until nursing home admission. The influence of extremely high loneliness on nursing home admission remained statistically significant after controlling for other variables, such as age, education, income, mental status, physical health, morale, and social contact, that were also predictive of nursing home admission. Several mechanisms are proposed to explain the link between extreme loneliness and nursing home admission. These include loneliness as a precipitant of declines in mental and physical health and nursing home placement as a strategy to gain social contact with others. Implications for preventative interventions are discussed.

Social support, infant temperament, and parenting self-efficacy: a mediational model of postpartum depression.

A model of maternal postpartum depression was tested in which difficult infant temperament was construed as a stressor and supportive interpersonal relationships were construed as a protective resource. It was hypothesized that both infant temperamental difficulty and level of social support would affect maternal depression through the cognitive mediation of perceived self-efficacy in the parenting role. Participants were 55 married women who were assessed during pregnancy and again 3 months postpartum. Infant temperament was assessed through observation, maternal crying records, and the Revised Infant Temperament Questionnaire. Results of a path analysis indicated that infant temperamental difficulty was strongly related to the mothers' level of postpartum depression, both directly and through the mediation of parenting self-efficacy. Consistent with predictions, social support appeared to exert its protective function against depression primarily through the mediation of self-efficacy. Both practical implications for identifying women at risk for postpartum depression and theoretical implications for understanding the mechanisms through which stressful events and social support affect adjustment are discussed.

Interpersonal variables in the prediction of alcoholism among adoptees: evidence for gene-environment interactions.

The contributions of genetic and both positive and negative environmental factors were tested in the prediction of alcohol abuse/dependence among 300 adult adoptees. No direct effects for either genetic or environmental factors were significant in the prediction of adoptee alcohol abuse/dependence. However, among women, early-life family conflict and psychopathology in the adoptive family interacted with a biological background of alcoholism. Among women with at least one alcoholic biological parent, conflict or psychopathology in the adoptive family increased the probability of alcohol abuse and/or dependence. Among men, no significant interactions were found between a biological background of alcoholism and environmental variables. Results suggest a pattern of gene-environment interaction among women.